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Patient Protection and Affordable Care Act (PPACA) › Centers for Medicare & Medicaid Services (CMS) › Provider Payments

The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal... more +
The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal subsidies to reduce the number of uninsured citizens. less -
ArentFox Schiff

Drastic Scheduled Cuts to Disproportionate Share Hospital Funding Would Increase Financial Distress for Safety Net Hospitals

ArentFox Schiff on

Over 2500 hospitals across the country historically have relied upon Disproportionate Share Hospital (DSH) Medicaid payments for financial stability. These DSH payments, made in large measure to hospitals with high Medicaid...more

Baker Donelson

If You're Reading This, You're Too Late: Key Drivers in Rising Health Care Defaults

Baker Donelson on

Health care bankruptcy filings more than tripled in 2017 as compared to 2016 with no end in sight to the financial struggles facing owners and operators in the sector. According to Bloomberg, health care bankruptcies have...more

Sheppard Mullin Richter & Hampton LLP

No Longer in Suspense: CMS Issues Final Rule Announcing that Risk Adjustment Program Transfers for 2017 will be Distributed in...

Sheppard Mullin Richter & Hampton LLP on

The Final Rule. In a Final Rule posted by CMS last Tuesday, July 24, 2018, CMS announced that $10.4 billion in “risk adjustment transfers” (“Risk Transfers”) for benefit year 2017 (as calculated pursuant to the Affordable...more

Baker Donelson

CMS Reinstates ACA Risk Adjustment Payments

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On Tuesday, July 24, the Centers for Medicare and Medicaid Services (CMS) issued a final rule intended to clarify the program methodology and reinstate payments under the Affordable Care Act's (ACA) permanent risk adjustment...more

Spilman Thomas & Battle, PLLC

SuperVision - Labor & Employment Law Insights - September 2017

Spilman Thomas & Battle, PLLC on

...This issue of SuperVision is dedicated to questions our friends and clients may have regarding insurance and benefit topics. While not a common part of the Labor & Employment field, Spilman prides itself on having...more

Baker Donelson

CMS Proposes QPP Revisions: The Paths for QPP Participation Continue to Evolve

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CMS recently proposed modified policies for continued implementation of the Quality Payment Program (QPP) in the 2017 Proposed Rule. Among other things, the Proposed Rule provides flexibility for clinicians in the second QPP...more

Mintz - Health Care Viewpoints

Provider Payments Under a Medicaid Per Capita Cap

Mintz - Health Care Viewpoints on

In a February 24th blog post, we described Medicaid block grants and per capita caps in terms of A x B = C to demonstrate how those payment policies work. ‘A’ is the amount a state is paid per beneficiary, ‘B’ is the number...more

Baker Donelson

New Bundled Payments Are a Go…For Now

Baker Donelson on

CMS issued a final rule on January 3, 2017, implementing three new episode payment models (EPMs) and a Cardiac Rehabilitation (CR) incentive payment model under the authority of the Center for Medicare & Medicaid Innovation...more

Baker Donelson

Final Rule Implements Quality Payment Program under MACRA

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If you are a physician, mid-level provider, or work with those providers, then you have been bombarded with new acronyms for new programs and promises to remove older acronyms from your Medicare vocabulary. Medicare...more

Burr & Forman

2016 Health Care Year in Review

Burr & Forman on

Since I began writing this year-end review in 2013, there have been some common themes – a shift to pay for quality and away from fee-for service, much of which has been brought about by the Affordable Care Act (ACA): efforts...more

Baker Donelson

CMS Releases the 2016 OPPS Final Rule

Baker Donelson on

On November 1, 2016, CMS published its final policy changes, quality provisions, and payment rates for 2017, as they relate to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center...more

King & Spalding

CMS Releases FY 2017 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final...

King & Spalding on

On August 2, 2016, CMS released a final rule (Final Rule) with updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) affecting...more

Baker Donelson

Home Health PPS CY 2017 Proposed Rule: Payments Rebased, Quality Measures Updated

Baker Donelson on

Downward adjustments to home health episode payments arising from rebasing of the national payment rates, case mix adjustments, and an increase to the fixed dollar loss ratio for calculating outliers will result in an overall...more

Manatt, Phelps & Phillips, LLP

Manatt on Medicaid: CMS Dramatically Expands Guidance on MMC Plan Payment

Manatt, Phelps & Phillips, LLP on

Editor's Note: This "Manatt on Medicaid" is the sixth in a series of updates focused on CMS's new Medicaid/CHIP managed care regulations. In the coming weeks, Manatt will continue to explore key provisions of the regulations...more

McDermott Will & Emery

Program Integrity Changes to the Medicare Provider Enrollment Process

McDermott Will & Emery on

On March 1, 2016, the U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) entitled “Medicare, Medicaid, and Children’s Health Insurance...more

Alston & Bird

A&B Healthcare Week in Review, November 2015

Alston & Bird on

I. REGULATIONS, NOTICES, & GUIDANCE - On November 21, 2015, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule entitled “Patient Protection and Affordable Care Act; HHS Notice of Benefit and...more

Polsinelli

You Are Now on the Clock — Sunshine Act Dispute Window Now Open

Polsinelli on

Beginning Monday, July 14, 2014, the review, dispute and correction process outlined the National Physician Payment Transparency Program (also known as the "Sunshine Act") opens on CMS's Open Payments website. Physicians and...more

Epstein Becker & Green

CMS Proposes Significant Rate Cuts and Other Changes to Medicare Advantage and Prescription Drug Plans

Epstein Becker & Green on

The Advance Notice ("Advance Notice") of Methodological Changes for Calendar Year ("CY") 2015 for Medicare Advantage ("MA") Capitation Rates, Part C and Part D Payment Policies and 2015 Call Letter was released by the Centers...more

Polsinelli

Polsinelli Podcast - Health Care Payment Changes: From Service to Value

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Healthcare is changing for consumers and providers under the Affordable Care Act. Less publicized is the way providers are now being paid and the way they will work together. In this week's Polsinelli "Inside Law," podcast,...more

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